The effect of pedicle screw instrumentation at a young age on upper thoracic vertebra and canal development |
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| Institution: | 1. Department of Orthopedic Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China;2. Beijing Key Laboratory for Genetic Research of Skeletal Deformity, Beijing, 100730, China;3. Key Laboratory of Big Data for Spinal Deformities, Chinese Academy of Medical Sciences, Beijing, 100730, China;4. Department of Emergency Surgery, Qilu Hospital of Shandong University, Jinan, Shandong Province, People’s Republic of China;5. Graduate School of Peking Union Medical College, Beijing, 100730, China;1. Department of Orthopedic Surgery, University of California - San Francisco (UCSF), 500 Parnassus Ave, MUW 3rd Floor, San Francisco, CA 94143, USA;2. Division of Gastroenterology, Department of Medicine, University of California - San Diego, La Jolla, 9500 Gilman Drive, La Jolla, CA 92093, CA, USA;3. Department of Neurological Surgery, UCSF, 400 Parnassus Ave, San Francisco, CA 94143, San Francisco, CA, USA;1. Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, 925 Chestnut St, 5th Floor, Philadelphia, PA 19107, USA;2. Feinberg School of Medicine, Northwestern University, 420 E Superior St, Chicago, IL 60611, USA;1. Shanghai Key Laboratory of Orthopaedic Implants and Department of Orthopaedic Surgery, Shanghai Ninth People''s Hospital, Shanghai Jiao Tong University, Shanghai 200011, China;2. School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Shanghai 200030, China;3. Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai 200030, China;1. Spine Center and Department of Orthopedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seongnam, Korea;2. Department of Orthopaedic Surgery, Chungnam National University School of Medicine, Daejeon, Korea;3. Department of Orthopedic Surgery, Spine Center, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea;1. Department of Internal Medicine, Walter Reed National Military Medical Center, 9499 Palmer Rd N, Bethesda, MD, 20814, USA;2. University of Utah, 201 Presidents'' Cir, Salt Lake City, UT 84112, USA;3. Defense and Veterans Center for Integrative Pain Management, Department of Anesthesiology, Uniformed Services University, 4301 Jones Bridge Rd, Bethesda, MD, 20814, USA;4. Henry M. Jackson Foundation for the Advancement of Military Medicine, 11300 Rockville Pike Suite 709, Rockville, MD 20852, USA;5. Department of Orthopedics, Brooke Army Medical Center, 3551 Roger Brooke Dr, Fort Sam Houston, TX, 78234-6200, USA;6. Department of Anesthesiology, Uniformed Services University, 4301 Jones Bridge Rd, Bethesda, MD, 20814;1. Department of Anesthesia and Intensive Care, Univ Rennes, CHU Rennes, Rennes, France;2. Department of Orthopaedics and Trauma, Univ Rennes, Inserm, LTSI-UMR 1099, Rennes University Hospital, Rennes, France;3. Department of Anesthesia and Intensive Care, Univ Rennes, CHU Rennes, Inserm, CIC-1414, COSS 1242, Rennes, France |
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| Abstract: | BACKGROUND CONTEXTPedicle screws are widely used in spinal surgeries. Pedicle screw fixation has shown better clinical effects than other techniques by providing steady fixation from the posterior arch to the vertebral body. However, there are several concerns about the impact of pedicle screw instrumentation insertion on vertebral development in young children, including early closure of the neurocentral cartilage (NCC). The effect of pedicle screw insertion in an early age on further growth of the upper thoracic spine is still unclear.PURPOSEThis study aimed to evaluate the impact of pedicle screw insertion on further growth of the upper thoracic vertebra and spinal canal.STUDY DESIGNA retrospective case study.PATIENT SAMPLETwenty-eight patients.OUTCOME MEASUREMENTSX-ray and CT parameters including length, height and area of the vertebrae and spinal canal were manually measured.METHODSTwenty-eight patients who underwent pedicle screw fixation (T1-T6) before the age of 5 years from March 2005 to August 2019 at Peking Union Medical College Hospital were recruited, and records were retrospectively reviewed. Vertebral body and spinal canal parameters were measured at instrumented and adjacent noninstrumented levels and compared using statistical methods.RESULTSNinety-seven segments met the inclusion criteria (average age at instrumentation 44.57 months, range from 23–60 months). Thirty-nine segments had no screws, and 58 had at least one screw. There was no significant difference between the preoperative and final follow-up values of the measurement of vertebral body parameters. No significant difference was observed between the growth rates in levels with or without screws in pedicle length, vertebral body diameter, or spinal canal parameters.CONCLUSIONPedicle screw instrumentation in the upper thoracic spine does not cause a negative effect on the development of the vertebral body and spinal canal in children younger than 5 years old. |
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